Comparison of mortality by femur fracture versus hip fracture in elderly patients in a period of five years
Main Article Content
Keywords
Hip fractures, Mortality, Survival, Elderly
Abstract
Background: Fractures in the elderly population are an economic, social and medical challenge. Not much is known about fractures in this population, which makes difficult the selection of an appropriate treatment. Hip fractures (HF) increase the risk of death and morbidity. Patients with midshaft femur fracture (MFF) have less morbidity and risk of death. The objective was to compare HF and MFF's survival.
Methods: Observational analytic study. The Hospital General de México database was used to gather patients aged 65 to 94 years with HF and MFF from 2010 to 2014. Patients had an heterogeneous follow-up and their cognitive status was not considered; we had a total of 146 patients. Follow-up was made through phone call.
Results: Kaplan-Meier estimate was used to assess survival. We compared survival depending on type of fracture and found no statistically significant difference (p = 0.97). On sub-analysis, we compared type of fracture on male gender (p = 0.21) and female gender (p = 0.316) and found no statistically significant difference on survival. This differs from what has been reported. It was used t test to evaluate survival in months, according to male (39.61 ± 19.1) and female (36.58 ± 23.19) gender; this showed a significant difference in both groups (p = 0.037).
Conclusions: In the presence of fractures, we must consider gender when estimating survival on patients with hip or midshaft femur fracture.
References
Kannus P, Parkkari J, Sievänen H, Heinonen A, Vuori I, Järvinen M. Epidemiology of hip fractures. Bone. 1996;18(1):57S-63S.
Wolinsky FD, Fitzgerald JF, Stump TE. The effect of hip fracture on mortality, hospitalization, and functional status: a prospective study. Am J Public Health. 1997;87 (3):398-403.
Bentler SE, Liu L, Obrizan M, Cook EA, Wright KB, Geweke JF, et al. The aftermath of hip fracture: discharge placement, functional status change, and mortality. Am J Epidemiol. 2009;170(10):1290-9. Disponible en https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2781759/
Neuman MD, Silber JH, Magaziner JS, Passarella MA, Mehta S, Werner RM. Survival and functional outcomes after hip fracture among nursing home residents. JAMA Intern Med. 2014;174(8):1273-80. Disponible en https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4122620/
Zuckerman JD. Hip Fracture. N Engl J Med. 1996;334 (23):1519-25.
Rubenstein LZ, Josephson KR. The epidemiology of falls and syncope. Clin Geriatr Med. 2002;18(2):141-58.
LeBlanc ES, Hillier TA, Pedula KL, Rizzo JH, Cawthon PM, Fink HA, et al. Hip fracture and increased short-term but not long-term mortality in healthy older women. Arch Intern Med. 2011;171 (20):1831-7. Disponible en https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3576923/
Morrison RS, Chassin MR, Siu AL. The medical consultant’s role in caring for patients with hip fracture. Ann Intern Med. 1998;128(12):1010-20.
Hedlund R, Lindgren U. Epidemiology of diaphyseal femoral fracture. ActaOrthop Scand. 1986;57(5): 423-7.
Arneson TJ, Melton LJ 3rd, Lewallen DG, O’Fallon WM. Epidemiology of diaphyseal and distal femoral fractures in Rochester, Minnesota, 1965-1984. Clin Orthop Relat Res. 1988;234:188-94.
Rahman O, Adnan RM, Khan R, Rahman F, Zia MZ, Amin J, et al. Pattern of femoral fractures. J Rawal Med Coll. 2013;17(1):42-4.
Bengnér U, Ekbom T, Johnell O, Nilsson B. Incidence of femoral and tibial shaft fractures. Epidemiology 1950-1983 in Malmö, Sweden. Acta Orthop Scand. 1990;61(3):251-4.
Weiss RJ, Montgomery SM, Al Dabbagh Z, Jansson KA. National data of 6409 Swedish inpatients with femoral shaft fractures: Stable incidence between 1998 and 2004. Injury. 2009;40(3):304-8.
Baron JA, Karagas M, Barrett J, Kniffin W, Malenka D, Mayor M, et al. Basic Epidemiology of Fractures of the Upper and Lower Limb among Americans over 65 Years of Age. Epidemiology. 1996;7(6):612-8.
Bucholz, R, Brumback R. Fractures of the shaft of the femur In: Rockwood CA, Green DP, Bucholz RW, Heckman JD, eds. Rockwood and Green’s Fractures in Adults. 4ed. Philadelphia: Lippincott-Raven; 1996. pp. 1827-8.
Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187-96.
Morshed S, Miclau T 3rd, Bembom O, Cohen M, Knudson MM, Colford JM Jr. Delayed internal fixation of femoral shaft fracture reduces mortality among patients with multisystem trauma. J Bone Joint Surg Am. 2009;91(1):3-13.
Lefaivre KA, Starr AJ, Stahel PF, Elliott AC, Smith WR. Prediction of pulmonary morbidity and mortality in patients with femur fracture. J Trauma. 2010;69(6):1527-35.
Anwar IA, Battistella FD, Neiman R, Olson SA, Chapman MW, Moehring HD. Femur fractures and lung complications: A prospective randomized study of reaming. Clin Orthop Relat Res. 2004;422:71-6.
Salminen S. Femoral shaft fractures in adults: epidemiology, fracture patterns, nonunions, and fatigue fractures (tesis doctoral en Internet). Helsinki: Department of Orthopedics and Traumatology, Department of Pediatric Surgery, University of Helsinki; 2005. Disponible en https://www.researchgate.net/profile/Sari_Salminen2/publication/47934387_Femoral_shaft_fractures_in_adults_Epidemiology_fracture_patterns_nonunions_and_fatigue_fractures/links/559ff13608aed84bedf449e2/Femoral-shaft-fractures-in-adults-Epidemiology-fracture-patterns-nonunions-and-fatigue-fractures.pdf?origin=publication _detail
Baztán JJ, Fernández-Alonso M, Aguado R, Socorro A. Resultados al año de la rehabilitación tras fractura de fémur proximal en mayores de 84 años. An Med Interna (Madrid). 2004;21(9):433-40.
Navarrete-Faubel FE, Baixauli-Perelló F, Baixauli-García F, Baixauli-Castellá F. Fracturas de cadera con tratamiento conservador: estudio epidemiológico. Rev Esp Cir Ortop Traumatol. 2001;45(3):2227. Disponible en http://www.elsevier.es/es-revista-revista-espanola-cirugia-ortopedica-traumatologia-129-articulo-fracturas-cadera-con-tratamiento-conservador-13015926